2014-11-20_REVISION - M2013018 (3)

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DIVISION OF RECLAMATION, MINING AND SAFETY Departrnent of Natural Resources 1313 Sherman St., Room 215 Denver, Colorado 80203 Phone: (303) 866 -3567 FAX: (303) 832 -8106 STATE OF COLORADO RfteveD NOV 2 0 2014 DIVISION OF RECL4At4TION CONSTRUCTION MATANV"p SAFM REGULAR (112) OPERATION RECLAMATION PERMIT APPLICATION FORM CHECK ONE: ✓Q— There is a File Number Already Assigned to this Operation COLORADO DIVISION OF RECLAMATION MINING SAFETY Permit # M 2013 018 (Please reference the file number currently assigned to this operation) New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Conversion Application (Rule 1.11) Permit # M 2013 Q18 - (provide for Amendments and Conversions of existing permits) The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; (2) Exhibits A -S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of Exhibits A -S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3 -ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. GENERAL. OPERATION INFORMATION Type or print clearly, in the space provided, ALL information requested below. 1. Applicant/overator or company name (name to be used on hermit): Pine Bluffs Gravel & Excavating Inc. 1.1 Type of organization (corporation, partnership, etc.): Corporation 2. Operation name (pit, mine or site name): Harms Pit 3. Permitted acrea¢e (new or existine site): 3.1 Change in acreage ( +) 3.2 Total acreage in Permit area 4. Fees: 4.1 New Application 4.2 New Quarry Application 4.4 Amendment Fee 4.5 Conversion to 112 operation (set by statute) 5. Primary commoditie(s) to be mined: sand gravel rock 5.1 Incidental commoditie(s) to be mined: 1. - lbs/Tons /vr 9.98 permitted acres 22.22 acres 32.2 acres $2.696.00 application fee $3,342.00 quarry application $2,229.00 amendment fee $2,696.00 conversion fee dirt 2. / lbs/Tons /vr 3. / Ibs/Tons /vr 4. / lbs/Tons/vr 5. / 1bs/Tons /vr 5.2 Anticipated end use of primary commoditie(s) to be mined: aggregate materials for road projects for US Government 5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A